Application of peroral cholangioscopy in an endemic area with high prevalence of hepatocellular carcinoma and choledocholithiasis

Background/Aims: Peroral cholangioscopy with a mother-baby scope system has been introduced for two decades. The paper presents the experience of peroral cholangioscopy at a university hospital in Taiwan where the prevalence of hepatocellular carcinoma and choledochohthiasis was high. Methodology: A total of 27 sessions of peroral cholangioscopy were performed in 26 patients during a period of 4 years. Of them, 20 patients were for diagnosis and the rest 6 for removing the retained biliary stones. Results: The overall successful rate was 96.3%. The post-procedure complication rate was 11.5% with 2 cholangitis and 1 gram-negative septicemia. There were a total of 19 successful diagnostic sessions. These resulted in definite histological diagnosis in 5 patients and more precise diagnoses subsequently confirmed by surgery in 5 patients. In the remaining 9 patients with tentative diagnoses, 5 confirmed their diagnoses but 4 patients changed their diagnoses after peroral cholangioscopy. By this procedure, hepatocellular carcinoma and choledocholithiasis can be well identified and differentiated. Conclusions: Peroral cholangioscopy is a safe and valuable modality in diagnosing and treating difficult biliary tract disease when handled with care. It is particularly useful in an endemic area with high prevalence of hepatocellular carcinoma and choledocholithiasis.